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Re-Challenge with Clozapine after Neuroleptic Malignant Syndrome and Seizure in a Patient with Di-George Syndrome: Case Report and Review of Literature

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Open Journal of Psychiatry 2020年第1期10卷 9-14页

作者： geetha Chandrashekar Ganesh Gopalakrishna Austin Campbell Katherine Edwards Muaid Ithman Department of Psychiatry University of Missouri Columbia USA Department Psychiatry University of Arizona Tucson USA Department of Pharmacy University of Missouri Health Care Columbia USA

Background: Individuals with 22q11.2DS, a genetic subtype of Schizophrenia, respond as well to clozapine as those with other forms of Schizophrenia. It has been reported that serious and rare adverse events like seizures, and myocarditis have been associated with clozapine treatment in this population. To the best of our knowledge, the incidence of neuroleptic malignant syndrome (NMS) as an adverse effect of antipsychotic use in patients with this disorder has not yet been reported. Aim: In this article, we discuss a case of clozapine-induced NMS and subsequent re-challenge in a patient with 22q11.2DS-associated schizophrenia. The aim of this study is to accumulate scientific data about rare presentations, and serve as a major educational tool, and highlight the unique challenges faced when using clozapine in a patient with DiGeorge Syndrome. Methods: This is a descriptive case report of a patient encountered in the inpatient unit which includes retrospective review of the patient’s electronic medical record and a literature review of antipsychotic medications-induced NMS. Conclusion: This study demonstrates a successful re-challenge with clozapine after the patient developed NMS and seizures during the initial treatment and also highlights how, in addition to drug level monitoring, considering pharmacogenetic testing early in treatment might help minimize adverse drug reactions in individuals with known genetic disorders such as 22q11.2DS.

关键词： Clozapine DiGeorge Syndrome 22q11.2 Deletion Syndrome Neuroleptic Malignant Syndrome (NMS) Seizure Re-Challenge

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Role of Silver Nitrate on in Vitro Flowering and Shoot Regeneration of Solanum nigrum (L.)—An Important Multipurpose Medicinal Plant

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American Journal of Plant Sciences 2016年第7期7卷 1021-1032页

作者： G. geetha K. Harathi C. V. Naidu Department of Biotechnology Dravidian University Kuppam India

Silver nitrate induced MS media enhanced multiple shoot regeneration and in vitro flowering from axillary bud and leaf explants of Solanum nigrum (L.) an important antiulcer medicinal plant. Healthy axillary bud and leaf explants were inoculated on MS medium supplemented with BAP/Kn (1.0 - 2.0 mg/l) in combination with IAA/NAA (0.5 mg/l) and AgNO3 (0.1 - 1.0 mg/l). The explants were responded effectively and good regeneration frequencies were observed in all the combinations of silver nitrate tested when compared to control. Maximum number of multiple shoots (34.3) was found in leaf explants cultured on MS media supplemented with BAP (2.0 mg/l), NAA (0.5 mg/l) and AgNO3 (0.4 mg/l). These regenerated shoots were sub-cultured on to the flowering media. Maximum number of in vitro flowers (12) was obtained from axillary bud explants in BAP (2.0 mg/l), Kn (1.0 mg/l), IAA (0.5 mg/l) and AgNO3 (6.0 mg/l) supplemented media when compared to leaf (4) and control. All the in vitro raised shoots were transferred to rooting medium supplemented with NAA, IBA (1.0 - 2.0 mg/l) and AgNO3 (0.1 - 0.6 mg/l). The best rooting response (24.6) was observed in 2.0 mg/l IBA + 0.4 mg/l AgNO3. The well rooted plantlets were transferred to polybags containing soil + vermiculate in 1:1 ratio for hardening and finally the hardened plantlets were transferred to field conditions.

关键词： In Vitro Flowering Micropropagation Silver Nitrate Ethylene Inhibitor Solanum nigrum

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Antineoplastic effects of deoxyelephantopin,a sesquiterpene lactone from Elephantopusscaber, on lung adenocarcinoma (A549) cells

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Journal of Integrative Medicine 2013年第4期11卷 269-277页

作者： Farha A. Kabeer geetha B. Sreedevi Mangalam S. Nair Dhanya S. Rajalekshmi LathaP. Gopalakrishnan Sujathan Kunjuraman Remani Prathapan Division of Cancer Research Regional Cancer Centre Jawaharlal Nehru Tropical Botanic Garden and Research Institute National Institute of Interdisciplinary Science and Technology

OBJECTIVE： Deoxyelephantopin, a sesquiterpene lactone from Elephantopus scaber, showed inhibition of the growth of various tumor cells in vitro. In the present study, we investigated the cytotoxicity and apoptosis-inducing capacity of deoxyelephantopin on lung adenocarcinoma （A549） cells. METHODS： The cytotoxic effect of deoxyelephantopin on A549 cells and normal lymphocytes was evaluated using 3-（4,5-dimethylthiazol-2-yl）-2,5-diphenyltetrazolium bromide （MTT） assay and 50% inhibitory concentration （IC50） value was determined. The self-renewal and proliferating potential of A549 cells after treatment with deoxyelephantopin were examined by colony formation assay. Cellular morphology of deoxyelephantopin-treated cells was observed using phase- contrast microscopy. The induction of apoptosis was evaluated using acddine orange and ethidium bromide staining, Hoechst 33342 staining, terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end-labeling （TUNEL） assay, DNA fragmentation analysis and Annexin V-fluorescein isothiocyanate staining by flow cytometry. Activation of caspases was detected using fluorogenic substrate specific to caspases 2, 3, 8 and 9 and flow cytometric analysis. The total cellular DNA content and expression of cleaved poly （ADP-ribose） polymerase was also analyzed. RESULTS： Deoxyelephantopin exhibited cytotoxicity to A549 cells （IC50 = 12.287 μg/mL）, however, there was no toxicity towards normal human lymphocytes. Deoxyelephantopin suppressed the colony-forming ability of A549 cells in a dose-dependent manner. Acridine orange, ethidium bromide and Hoechst 33342 staining showed cell shrinkage, chromosomal condensation and nuclear fragmentation, indicating induction of apoptosis. Deoxyelephantopin increased apoptosis of A549 cells, as evidenced by more TUNEL-positive cells. DNA fragmentation and Annexin V staining revealed late-stage apoptotic cell population. Deoxyelephantopin inhibited A549 cell growth by cell cycle arrest at G2/M phase an

关键词： herbal medicine lung neoplasms Elephantopus scaber , deoxyelephantopin apoptosis caspases cell line, tumor A549 cells

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Energy-Delay Efficient Unified Routing Protocol for Wireless Sensor Networks

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Circuits and Systems 2016年第6期7卷 995-1007页

作者： V. P. Jayachitra G. geetha K. Santhan Vijay Department of Computer Technology MIT Campus Anna University Chennai India Department of Computer Science & Engineering Jerusalem College of Engineering Anna University Chennai India

One of the most important challenges in the Wireless Sensor Networks is to improve the performance of the network by extending the lifetime of the sensor nodes. So the focus is on obtaining a trade-off between minimizing the delay involved and reducing the energy consumption of the sensor nodes which directly translate to an extended lifetime of the sensor nodes. An effective Sleep-wake scheduling mechanism can prolong the lifetime of the sensors by eliminating idle power listening, which could result in substantial delays. To counter this, an anycast forwarding scheme that could forward the packet opportunistically to the first awaken node may result in retransmissions as if the chosen node falls in resource constraints. The algorithm, namely Prim’s-Dual is proposed to solve the said problem. The algorithm considers five crucial parameters, namely the residual energy of the nodes, transmission power, receiving power, packet loss rate, interference from which the next hop is determined to extend the lifetime of the sensor node. Since the proposed work is framed keeping critical event monitoring in mind, the sleep-wake scheduling is modified as low-power, high-power scheduling where all nodes are in low-power and the nodes needed for data transmission are respectively turned on to high-power mode. The integrated framework provides several opportunities for performance enhancement for conflict-free transmissions. The aim of our algorithm is to show reliable, energy efficient transfer without compromising on lifetime and delay. The further effectiveness of the protocol is verified. The results demonstrate that the proposed protocol can efficiently handle network scalability with acceptable latency and overhead.

关键词： Angle Based Routing Cross-Layer Energy-Delay Trade-Off Medium Access Control (MAC) Prims-Dual Minimum Spanning Tree

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A Rare Case of Facial Palsy Due to Mucormycosis

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International Journal of Otolaryngology and Head & Neck Surgery 2015年第3期4卷 224-228页

作者： Vaishali Shah H. Ganapathy Ram Gopalakrishnan N. geetha ENT Department Apollo Main Hospital Chennai India Infectious Diseases Department Apollo Main Hospital Chennai India Pathology Department Apollo Main Hospital Chennai India

A very uncommon instance of facial nerve palsy involving isolated temporal bone with associated uncontrolled diabetes mellitus has been noticed. A 53-year-old diabetic male presented himself with facial asymmetry, ear pain, and discharge in the right ear of one-month duration. Clinical examination revealed grade IV [House-Brackmann] right sided facial palsy, and otoscopy of small central perforation. Clinically acute otitis media with facial palsy diagnosis was made. There was minimal response to medical treatment. As per CT scan and audiometry findings, patient was subjected for exploratory mastoidectomy showing pale granulation tissue involving geniculate ganglion of facial nerve. The histopathology was suggestive of mucormycosis, an unusual presentation in middle ear. The patient was treated with injectable Amphotericin B. This case highlights a rare cause of isolated facial palsy and physicians should be aware of such atypical clinical presentation.

关键词： Facial Palsy Diabetes Mellitus Mucormycosis

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Rapid LC-ESI-MS-MS Method for the Simultaneous Determination of Sitagliptin and Pioglitazone in Rat Plasma and Its Application to Pharmacokinetic Study

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American Journal of Analytical Chemistry 2012年第12期3卷 849-858页

作者： Samanthula Gananadhamu Vaddepally Laxmikanth Saladi Shantikumar Veeraraghavan Sridhar Caringula.geetha Chennupati Sandhya Department of Pharmaceutical Analysis National Institute of Pharmaceutical Education and Research (NIPER) Hyderabad India Drug Metabolism and Pharmacokinetics Department Incozen Therapeutics Private Limited Hyderabad India

A liquid chromatography tandem mass spectrometry (LC-MS/MS) based method was developed for the simultaneous monitoring plasma levels of Sitagliptin (STG) and Pioglitazone (PIO) for applicability to pharmacokinetic studies. The method was based on HPLC separation on the reversed phase Phenomenex Synergy C18 column (30 mm length, 4.6 mm internal diameter, and 4.0 μm particle size) at a temperature of 40?C using a binary gradient mobile phase consisting of methanol and 2 mM ammonium acetate buffer pH adjusted to 4.5 with acetic acid, at a flow rate of 1 mL?min?1. Tolbutamide was used as an internal standard. Detection of analytes was achieved with LC-MS/MS system in Multiple Reaction Monitoring (MRM) mode. The method was validated over concentration range of 10.98 - 2091.77 ng?mL?1 for SIT and 8.25 - 1571.63 ng?mL?1 for PIO and lower limit of quantification was 10.98 ng?mL?1 and 8.25 ng?mL?1 for STG and PIO respectively. Recoveries from spiked controls were within acceptance criteria for all the analytes and internal standard at all QC levels. Within batch and between batch accuracy for STG was found within 96.9% - 100.3% and for PIO was found within 100.0% - 104.3%. Within batch and between batch precision for STG was less than 3.1% CV (coefficient of variation) and for PIO was less than 5.3% CV at all concentrations levels. This method was successfully applied to monitor pharmacokinetics profile of both STG and PIO on simultaneous oral administration to rats. This method can be applicable for pharmacokinetic drug-drug interaction studies.

关键词： Sitagliptin Pioglitazone LC-MS/MS Bioanalytical Method Validation

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TCRAIN–A DATABASE OF TROPICAL CYCLONE RAINFALL PRODUCTS FOR NORTH INDIAN OCEAN

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Tropical Cyclone Research and Review 2014年第2期3卷 122-129页

作者： S.BALACHANDRAN B.geetha K.RAMESH N.SELVAM Cyclone Warning Research Centre Regional Meteorological Centre

Analysis of tropical cyclone(TC) rainfall characteristics helps in understanding and improving quantitative precipitation forecasts of TCs. Based on the Tropical Rainfall Measuring Mission(TRMM) rainfall data for the period of 2000-2010, a TC rainfall database –Tropical Cyclone Rainfall Analysis for North Indian Ocean(TCRAIN) is developed to study the precipitation characteristics during various stages of life cycle of TCs of the North Indian Ocean(NIO). Three rainfall products, viz., frequency distribution of rain rate, azimuthally averaged radial profile of rain rate and quadrant mean rain rate with respect to the TC centre and the direction of motion of the TC are generated in a Lagrangian frame of coordinate system for 5 intensity stages of life cycle of each cyclone over NIO. Using this TCRAIN database, composites of frequency distribution of rain rates as well as quadrant mean rain rate for TCs of NIO are generated to bring out probable rain rates and asymmetric structure in rainfall distribution. Rainfall profiles for individual cases are likely to deviate from the climatological profiles under different environmental and oceanic conditions. TCRAIN database would serve as a useful tool for carrying out intensity based analytical studies on structure of rainfall associated with cyclones of NIO through ready depiction of TC rainfall profiles.

关键词： tropical cyclone rainfall radial profi le quadrant mean TCRAIN

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Maxillofacial trauma in a pregnant patient:Contemporary management principles with a case report&review of literature

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Chinese Journal of Traumatology 2020年第2期23卷 78-83页

作者： geetha Sridharan Elavenil Panneerselvam Keerthana Ponvel Swetha Tarun V.B.Krishna Kumar Raja Department of Oral and Maxillofacial Surgery SRM Dental College and HospitalRamapuram CampusRamapuramChennai 600089Tamil NaduIndia

Trauma during pregnancy deserves special attention because of its management objectives,***-being of both pregnant woman and *** trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth *** and breathing,Hence early restitution of form and function of maxillofacial skeleton is ***,the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment.A careful scrutiny of the patient's systermic and gestational status is absolutely essential before,during and after instituting any interventional *** present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester(32 weeks).She was treated with inter maxillary fixation using orthodontic brackets&*** successful restitution of occlusion,the patient was advised aggressive physiotherapy which ensured normal mouth *** weeks later,the patient delivered *** patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion,mouth opening and lower|acial *** article aims at analyzing the contermporary principles in management of maxillfacial trauma in a pregnant woman and clarifying the common misconceptions.

关键词： Trauma Pregnancy Foetus Condyle fracture

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Experimental Investigation of Drilling Fluid Performance as Nanoparticles

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World Journal of Nano Science and Engineering 2013年第3期3卷 57-61页

作者： Jamal Nasser Anna Jesil Tariq Mohiuddin Majid Al Ruqeshi geetha Devi Shahjahan Mohataram Mechanical & Industrial Engineering Department Caledonian College of Engineering Muscat Oman Sultan Qaboos University Al khoudh Oman

In this work, a drilling fluid recipe has been developed by using nanoparticles, to increase the efficiency of drilling operations for maximum accessibility to new & matured oil reserves and suited to various drilling conditions. The solution to severe drilling problems like pipe sticking, lost circulation, formation damage, erosion of borehole, thermal instability of drilling fluids and insufficient gel properties of the drilling fluids, lies in controlling and optimizing the rheology of the drilling fluid. The inefficiency of the drilling fluid in performing certain functions is mainly due to a lack in a particular rheological property. The performance of the clay composites water-based bentonite drilling mud in terms of its rheological behavior in drilling systems was investigated at various pressures and temperatures. It was found that temperature had a detrimental effect on the rheological properties. The behavior was investigated using synthesized nano bentonite water based drilling fluid. The fluid retained all the desired rheological properties at elevated temperatures and pressures, thus enhanced the possibility of its application in deep wells, where elevated temperatures and pressures were quite common.

关键词： Drilling Fluid Nanoparticles Mud Viscosity Density

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Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

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World Journal of Virology 2023年第5期12卷 286-295页

作者： Harinivaas Shanmugavel geetha Sushmita Prabhu Abinesh Sekar Maya Gogtay Yuvaraj Singh Ajay K Mishra George M Abraham Suzanne Martin Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Hospice and Palliative Medicine University of Texas Health-San AntonioSan AntonioTX 78201United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States Department of Nephrology Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal *** To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and *** We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-Ⅴ*** primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no *** analyses used unpaired t-test for continuous variables and chi-square analysis for categorical *** for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/*** 290 were screened,and 118 met the inclusion ***,D-dimer,and ferritin were significantly different among the three *** univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD *** AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-Ⅴ*** may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

关键词： Coronavirus disease 2019 Chronic kidney disease Inflammatory markers C-reactive protein Invasive mechanical ventilation Non-invasive mechanical ventilation

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